Provider Demographics
NPI:1124418041
Name:HOSPICE OF GREATER CHICAGO, LLC
Entity Type:Organization
Organization Name:HOSPICE OF GREATER CHICAGO, LLC
Other - Org Name:SANCTUARY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-977-9711
Mailing Address - Street 1:500 FAULCONER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5089
Mailing Address - Country:US
Mailing Address - Phone:434-977-9711
Mailing Address - Fax:434-977-9715
Practice Address - Street 1:1727 S INDIANA AVE
Practice Address - Street 2:SUITE G2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1345
Practice Address - Country:US
Practice Address - Phone:630-226-1306
Practice Address - Fax:630-226-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2003129251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
141648Medicare Oscar/Certification